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Aspirin and mortality from coronary bypass surgery
1Ischemia Research and Education Foundation, San Francisco, CA 94134, USA. dtb@iref.org
Insights
Early aspirin use after coronary bypass surgery significantly reduces mortality and ischemic complications. This safe treatment improves survival rates and prevents serious adverse events in patients.
Area of Science:
- Cardiovascular Surgery
- Pharmacology
- Clinical Medicine
Background:
- Coronary bypass surgery lacks therapies to mitigate post-operative complications and mortality.
- Platelet activation is a key factor in atherosclerotic injury, suggesting a role for antiplatelet agents.
Purpose of the Study:
- To evaluate the efficacy of early aspirin administration in reducing mortality and ischemic complications following coronary bypass surgery.
Main Methods:
- A prospective study involving 5065 patients across 70 international centers, with 5022 surviving the initial 48 hours post-surgery.
- Data on 7500 variables per patient were collected, and outcomes were centrally adjudicated to determine the relationship between early aspirin use and patient outcomes.
Main Results:
- Aspirin use within 48 hours post-revascularization was associated with a significant reduction in mortality (1.3% vs. 4.0%, P<0.001).
- Aspirin therapy demonstrated substantial risk reductions for myocardial infarction (48%), stroke (50%), renal failure (74%), and bowel infarction (62%).
- Multivariate analysis confirmed aspirin's independent protective effect, with no increased risk of hemorrhage, gastritis, infection, or impaired wound healing.
Conclusions:
- Early aspirin administration following coronary bypass surgery is a safe and effective intervention.
- Aspirin use is linked to decreased mortality and a lower incidence of major ischemic complications affecting the heart, brain, kidneys, and gastrointestinal system.
Background:
There is no therapy known to reduce the risk of complications or death after coronary bypass surgery. Because platelet activation constitutes a pivotal mechanism for injury in patients with atherosclerosis, we assessed whether early treatment with aspirin could improve survival after coronary bypass surgery.
Methods:
At 70 centers in 17 countries, we prospectively studied 5065 patients undergoing coronary bypass surgery, of whom 5022 survived the first 48 hours after surgery. We gathered data on 7500 variables per patient and adjudicated outcomes centrally. The primary focus was to discern the relation between early aspirin use and fatal and nonfatal outcomes.
Results:
During hospitalization, 164 patients died (3.2 percent), and 812 others (16.0 percent) had nonfatal cardiac, cerebral, renal, or gastrointestinal ischemic complications. Among patients who received aspirin (up to 650 mg) within 48 hours after revascularization, subsequent mortality was 1.3 percent (40 of 2999 patients), as compared with 4.0 percent among those who did not receive aspirin during this period (81 of 2023, P<0.001). Aspirin therapy was associated with a 48 percent reduction in the incidence of myocardial infarction (2.8 percent vs. 5.4 percent, P<0.001), a 50 percent reduction in the incidence of stroke (1.3 percent vs. 2.6 percent, P=0.01), a 74 percent reduction in the incidence of renal failure (0.9 percent vs. 3.4 percent, P<0.001), and a 62 percent reduction in the incidence of bowel infarction (0.3 percent vs. 0.8 percent, P=0.01). Multivariate analysis showed that no other factor or medication was independently associated with reduced rates of these outcomes and that the risk of hemorrhage, gastritis, infection, or impaired wound healing was not increased with aspirin use (odds ratio for these adverse events, 0.63; 95 percent confidence interval, 0.54 to 0.74).
Conclusions:
Early use of aspirin after coronary bypass surgery is safe and is associated with a reduced risk of death and ischemic complications involving the heart, brain, kidneys, and gastrointestinal tract.
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